Analysis of risk factors for early mortality and multiorgan failure after pericardiectomy for constrictive pericarditis

Abstract

Background:. The operative mortality of pericardiectomy is still high. This prospective study was to determine the risk factors for early mortality and multiorgan failure.Methods: We prospectively observe patients undergoing pericardiectomy from January 2009 to June 2020 at our hospital. Radical pericardiectomy was performed via sternotomy. Histopathologic studies of pericardum tissue from every patient was done. All survivors were monitored to the end date of the study.Results: 92 consecutive underdoing pericardiectomy for constrictive pericarditis were included in the study. Postoperatively ,CVP decreased significantly, and LVED and LVEF improved significantly. The overall mortality rate was 5.4%. The common postoperative complications inclued acute renal injury（27.2%）, low cardiac output syndrome (10.9% ), and multiorgan failure (8.7%). Analysis of risk factor showed that D2 (fluid balance of the second day following operation) was associated with decreased early mortality and decreased multiorgan failure. In this series from Guagxi, China, characteristic histopathologic features of tuberculosis（60/92,65.2%） of pericardium were the most common histopathologic findings, and 32 patients (32/92,34.8%) had the histopathologic findings of chronic nonspecific inflammatory changes. The functional status of the patients improved after pericardiectomy, 6 months postoperatively 85 survivors were in class I (85/87, 97.7%) and 2 in class II (2/87, 2.3%) .Conclusions: Our results show that pericardiectomy is an effective procedure in the treatment of constrictive pericarditis Early surgical intervention is advocated. Improvement of surgical technique and intraoperative and perioperative management can decrease mortality and morbidity.